title: Effect of prolonged thienopyridine use after drug-eluting stent implantation (from the TAXUS landmark trials data).
abstract: Previous observational studies have evaluated the utility of prolonged thienopyridine therapy in patients receiving drug-eluting stents, with conflicting results. A landmark analysis was therefore performed on the basis of the prospective, double-blind TAXUS-II SR, TAXUS-IV, and TAXUS-V trials. Of 2,736 randomized patients, 2,171 were event free at 1 year, of whom 964 (44.4%) at physician discretion were still taking thienopyridines at that time. Among the 1,141 event-free patients randomized to Taxus stents, a trend was present in those patients still taking compared with those having discontinued thienopyridines at 1 year to have numerically fewer very late stent thrombosis episodes at 2 years (0 vs 4 [0.7%] events, respectively, p = 0.07) and 5 years (4 [0.8%] vs 8 [1.4%] events, respectively, p = 0.43). However, in event-free Taxus patients taking compared with those not taking thienopyridines at 1 year, there were no significant differences in the 2- and 5-year rates of death (1.4% vs 0.6%, p = 0.22, and 6.0% vs 7.4%, p = 0.83, respectively) and death or myocardial infarction (1.8% vs 1.9%, p = 0.82, and 8.3% vs 9.8%, p = 0.75, respectively). There were no significant interactions between 1-year thienopyridine use status and stent type (Taxus vs bare-metal stent) on the individual or composite end points of stent thrombosis, death, or myocardial infarction at either 2 or 5 years (all interaction p values >0.50). In conclusion, thienopyridine use beyond 1 year after drug-eluting stent implantation may reduce stent thrombosis over the subsequent 12-month period, but the rates of death and myocardial infarction at 2 and 5 years are not prevented by extended thienopyridine use after either drug-eluting or bare-metal stent implantation.
authors.affiliation: The Cardiovascular Research Foundation, New York, New York, USA. gs2184@columbia.edu
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: Mark
authors.initials: M
authors.lastname: Friedman
authors.forename: Donald S
authors.initials: DS
authors.lastname: Baim
mesh_terms: D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D011446:Prospective Studies; D011725:Pyridines / Q000008:administration & dosage*; D055502:Secondary Prevention; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D011725:Pyridines; C446540:thienopyridine